SELF-CATHETERISATION A Guide for Male Patients PATIENT EDUCATION ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 1
This booklet has been designed to help you learn how to perform self-catheterisation. Feel free to discuss any issues and questions you may have with the medical and nursing staff looking after you. Self-catheterisation This form of treatment is designed to help people who cannot empty their bladder properly. You may also hear it referred to as intermittent self-catheterisation (ISC). It is important to empty the bladder regularly throughout the day for the following reasons: Urine that is left in the bladder for long periods of time can become infected. Overstretching of the bladder can cause damage to the bladder and may lead to incontinence (leakage) of urine. Overstretching of the bladder and urinary tract infections may lead to kidney damage. Urine that is left in the bladder for long periods may form stones. The technique of self-catheterisation involves learning to pass a small plastic tube (catheter) into the bladder. You will be taught this procedure by a Nurse and will be given the opportunity to practise under supervision until you are confident that you can manage on your own ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 2
How Often Should I Catheterise? You should perform self-catheterisation as often as your doctor or nurse has recommended. This depends on how much urine you are passing and how much urine is left in the bladder. However, performing self-catheterisation should fit in around your day-today activities and not the other way around. If you are performing self-catheterisation for a temporary bladderemptying problem and have not been told how often you should do it, follow these frequency guidelines: begin by doing it four times a day, for example, first thing in the morning, a couple of times during the day and before you go to bed at night if the urine drained from passing the catheter during the day is less than 100-150mls for three consecutive days, you may decrease the frequency to three times a day if the urine residuals continue to be less than 100-150mls for three consecutive days decrease the frequency to two times a day, then once a day three times a week twice a week weekly possibly not having to do it at all ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 3
If you are performing self-catheterisation to prevent the urethra (the urine pipe) from narrowing, you will need to follow these frequency guidelines: perform self-catheterisation every day for a month, then alternate days for a month three to four times a week for a month twice weekly for a month weekly for a month and possibly monthly The frequency of self-catheterisation is dependent on how easy it is to pass the catheter each time and you may have to increase or decrease the frequency dependent on this. Who is Available to Help? Your District Nurse and GP (family doctor) will help you to manage your catheter at home. Your District Nurse will visit you at home and give you practical help and advice as well as supplies of the Nelaton catheters. Your Anatomy Before you learn the procedure for self-catheterisation, you will need an understanding of your anatomy. ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 4
Please study the diagram below. Equipment You will need the following equipment: Nelaton plastic catheters Container for urine eg. jug Rubbish bag Lubricant eg. Xylocaine jelly in a 10mil syringe (this is a lubricant and local anaesthetic) Toilet tissue Container with a well fitting lid to store the catheter in after use i.e. a clean ice-cream container or preserving jar ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 5
The Procedure Step by Step 1. WASH YOUR HANDS THOROUGHLY. 2. Prepare the equipment, setting everything up on a clean, easily-accessible surface. 3. Holding the penis with one hand, clean the end of the penis with wet tissue or cleaning wipes (if you have not been circumcised, draw back the foreskin). Wipe from the centre outwards and use each tissue once only. Discard used tissues into the rubbish bag or toilet. 4. WASH YOUR HANDS AGAIN and position yourself comfortably. 5. Coat the tip of the catheter with lubricating jelly. Hold the penis almost upright and insert the nozzle of the Xylocaine jelly syringe into the urethral opening. Squeeze the jelly into the penis and remove the nozzle gently pinch the end of the penis so that the jelly is retained. Wait approximately three minutes for the jelly to take effect. 6. Keep holding the penis almost upright and pick up the catheter with your free hand. Do not let the catheter tip touch any objects. Gently insert the catheter into the urethra ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 6
when you meet resistance from your sphincter muscles stop inserting the catheter. 7. Take a few slow, deep breaths and keep a gentle, steady pressure on the catheter. As the sphincter muscles relax, the catheter will slip into the bladder and urine will start to flow out. Have the container ready to catch the urine or let it drain into the toilet. 8. Leave the catheter in the bladder until the urine stops flowing. Withdraw the catheter slowly. If the urine flow restarts, stop removing the catheter until there is no more urine flowing. Remove the catheter; dry yourself (return foreskin to normal position). 9. WASH YOUR HANDS. 10. Return your foreskin to it s normal position if not circumcised Important Never use force or be in a hurry when inserting the catheter. While you are learning the technique, and if you have recently undergone surgery of the urinary system, it is advisable to use Xylocaine anaesthetic/lubricating jelly. Jerky movements of the catheter will cause spasm of the sphincter muscles and you will be unable to pass the catheter. If you cannot pass the catheter, abandon the attempt and try again later. If you continue to have difficulty, seek help from your District Nurse or GP (family doctor). After approximately 7-10 days when you are confident or have recovered from surgery, you may use KY jelly for lubrication. ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 7
Instead of inserting the jelly into the urethra you should dip the end of the catheter into the jelly. You will then be ready to insert the catheter into your penis. Catheter Care Rinse the catheter after use making sure that the eye of the catheter is not blocked. Wash the catheter in warm, soapy water then rinse it thoroughly in clean, running water. Shake the catheter to remove any residual water. Your catheter should be stored dry in a clean container with a lid. Do not let anyone else touch your catheter or container. Clean your container at least once a week using a mild bleach solution. Ensure the container is kept dry at all times. Each catheter may be used for one week. Fluid Intake Unless your doctor has told you otherwise, you are advised to drink approximately 2 litres of fluid a day. This is about equal to 8-10 cups. Your urine should be a light yellow colour. ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 8
Hygiene Always wash your hands thoroughly and follow the recommended guidelines when performing the catheterisation technique and when cleaning your equipment. Recognising Infection A complication sometimes associated with catheterisation is infection. This is because the catheter provides a direct route for bacteria to enter the bladder. Signs of infection to watch out for: Do you feel unwell tired, loss of appetite, vomiting? Do you have a fever, shivering, or chills? Do you have pain over the bladder? Do you have pain or aching in your back? Is your urine cloudy or does it have an offensive odour? Is there blood in your urine? If you have some or all of these signs and symptoms, contact your GP PROMPTLY as they indicate that you may have a urinary tract infection. As long as you adhere to the clean technique you should stay free of infections. However, some people may require low-dose antibiotics or medications to achieve this. Occasionally you may notice some debris or floating particles in your urine. This is usually due to crystals or salts in the urine you should drink more fluid. ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 9
Supplies While you are in hospital your hospital nurse will provide you with a new catheter each time you catheterise. At home you do not need a new catheter each time you catheterise. It is usual to use the same catheter for one week When you are discharged from hospital your hospital nurse will provide you with some initial supplies. Once you are at home the District Nurse will visit and check that you are managing. The District Nurse will also provide you with supplies of Nelaton catheters, NOT lubricating jelly. When your hospital supply has been use, you will need to buy K-Y jelly form your chemist or supermarket or alternatively your District Nurse may suggest you moisten the Nelaton Catheter with water to make it slippery before use. If you go away on holiday, remember to take any supplies you may need with you. ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 10
Useful Telephone Numbers GP (family doctor) Always call your GP if you are unwell. District Nurse The District Nurse is not available at night. YOUR PERSONALISED PLAN This plan will be updated by your Nurse as the need arises. Sometimes the failure of the bladder to empty properly is a temporary problem. In time you may be able to decrease the number of times you use a catheter. This will depend on how much urine you are passing and how much is left in the bladder. Date: Date: Date: Date: 3 References: Mosby s Genitourinary Disorders, Clinical Nursing, Mikel Gray 1992 Urological Nursing 3rd Edition, Urological Nursing 2004 Campbell's Urology 7th Edition, Urology, 1998 ADHB Urology Department; Reviewed JULY 2005 Ubix code NPEB2 11